Therapy for Narcissistic Personality Disorder: Treatment

Therapy for narcissistic personality disorder utilizes evidence-based approaches including psychodynamic psychotherapy, cognitive behavioral therapy, and schema-focused therapy to reduce NPD symptoms and improve interpersonal relationships through structured therapeutic intervention with qualified mental health professionals.

When relationships feel impossible and conflicts seem endless, Narcissistic Personality Disorder may be more than just self-centeredness - it's a complex condition that therapy can genuinely help transform through proven approaches like psychodynamic therapy and CBT.

Content warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

The term “narcissist” has become increasingly common in everyday conversation, but experiencing the mental health condition known as narcissistic personality disorder (NPD) is far more complex than simple self-absorption. People with NPD often struggle to form intimate and satisfying relationships with others and may experience persistent conflicts in their professional and social lives that significantly impact their overall well-being.

Narcissistic personality disorder may develop from various factors, including exposure to narcissistic traits during childhood or having experienced early trauma. Regardless of what has contributed to the development of NPD, working with a qualified therapist may help reduce the prevalence of NPD symptoms through several evidence-based therapeutic techniques.

Understanding narcissistic personality disorder (NPD)

Narcissistic personality disorder is a diagnosable mental health condition with specific criteria that must be met for an official diagnosis. It extends far beyond occasionally displaying narcissistic tendencies such as self-centeredness or being dismissive of others’ feelings. Narcissistic personality disorder can create significant conflict in families and other close relationships, marriages, social settings, and workplaces.

Clinical definition of narcissistic personality disorder

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-V) defines narcissistic personality disorder as a “pervasive pattern of grandiosity, need for admiration, and lack of empathy, with interpersonal entitlement, exploitative behavior, arrogance, and envy.”

Individuals with NPD may demonstrate a variety of symptoms that increase the likelihood of unhealthy relationship patterns in their lives and, in significant cases, perpetrate narcissistic abuse.

Recognizing NPD symptoms

• Self-enhancement and excessive self-centeredness
• Arrogant demeanor and communication style
• Fantasizing about or, in extreme cases, believing they are destined to experience extraordinary success, perfect romantic love, beauty, power, or brilliance
• Paradoxical low self-esteem (individuals with NPD often outwardly appear to think highly of themselves while inwardly experiencing deep insecurity)
• Hypersensitivity to criticism, failures, perceived humiliations, or “defeats,” and a tendency to avoid situations that may result in those outcomes
• Constant need for attention and admiration from others
• Difficulty regulating emotions, particularly frustration and anger
• Increased likelihood of developing other personality disorders, such as borderline personality disorder
• Higher risk of developing mood disorders, including depression or bipolar disorder
• Limited sensitivity to other people’s needs and feelings
• Reduced ability to collaborate effectively with others
• Challenges with commitment or forming close, authentic relationships
• Persistent desire for competition or acting competitive in inappropriate contexts
• Frequently criticizing others or comparing them unfavorably to oneself
• Tendency to exploit others to achieve personal goals, operating with a belief that “the ends justify the means”
• Patronizing, condescending, or dismissive behavior toward those they perceive as inferior
• Frequent dishonesty or misrepresentation of facts
• Antagonistic or deliberately provocative behavior
• Manipulating or exploiting others for personal gain

Therapeutic approaches for narcissistic personality disorder

While NPD cannot necessarily be cured, several treatment methods may help significantly reduce symptoms and improve quality of life. One of the most successful forms of treatment is talk therapy with a qualified mental health professional.

People with NPD may be unlikely to seek therapy on their own initiative, as one of the hallmarks of the disorder is limited self-awareness or a belief that one’s behavior is justified. As a result, individuals with NPD may first encounter counseling through family therapy due to persistent challenging family dynamics. If they do pursue individual therapy, it may be at the request of family members or loved ones. Regardless of what has led a person with NPD to therapy, several therapeutic treatments have shown effectiveness in clinical practice.

Psychodynamic psychotherapy for NPD

Psychodynamic psychotherapy is widely considered one of the most effective treatment methods for personality disorders, including narcissistic personality disorder. Its primary focus is helping the client understand patterns in their interpersonal relationships and overall psychological functioning.

A therapist employing psychodynamic psychotherapy may work with their client to address emotional avoidance and explore past and present experiences that may be contributing to unhelpful behavior patterns. This approach emphasizes the therapeutic relationship itself as a vehicle for change and insight.

Cognitive behavioral therapy (CBT) applications

Cognitive behavioral therapy is one of the most common treatments for various mental health conditions. It explores the connection between a person’s thoughts and behaviors, based on the understanding that changing unhealthy thought patterns can lead to behavioral change and overall improvement in well-being.

Cognitive behavioral therapy may not be effective for everyone with NPD, particularly those with limited insight into their patterns. However, it might benefit those who can engage with examining their thoughts and behaviors. Core tenets of CBT that may help someone with NPD include validation, psychoeducation, and identifying and addressing specific target behaviors to modify.

Transference-focused psychotherapy (TFP)

Transference-focused psychotherapy emphasizes reflection and increasing a client’s understanding of their internal emotional states and the ways these states impact how they interact with others.

With TFP, a therapist helps clients develop perspective-taking and emotional regulation skills, which can address NPD symptoms such as shame, feelings of inferiority, envy, humiliation, entitlement, defensiveness, grandiosity, and aggression. The therapeutic relationship becomes a laboratory for examining and changing interpersonal patterns.

Schema-focused therapy for early patterns

Similar to cognitive behavioral therapy, schema-focused therapy is used to treat various mental health conditions. It focuses on schemas—thoughts and behavior patterns learned at a young age. Because schemas are deeply ingrained, people are often unaware of such patterns and how they affect their current lives.

Schema-focused therapy may benefit people with narcissistic personality disorder, as current research understands the disorder to potentially develop based on early childhood experiences. Schema-focused therapy for NPD often addresses several cognitive distortions associated with narcissistic thinking, such as perfectionism, the belief that one is devalued by others, and a rigid, unchanging, “black and white” perception of the world.

Finding the right therapist for NPD treatment

If you believe you may be experiencing narcissistic personality disorder, finding a therapist skilled in treatments that specifically address your symptoms can be beneficial. A qualified therapist can help you navigate your challenges and support you in improving your mental health and relationships.

The importance of specialized expertise

Not all therapists have extensive experience treating personality disorders. When seeking treatment for NPD, consider looking for licensed clinical social workers or other mental health professionals who have specific training and experience with personality disorders and the therapeutic modalities described above.

Important note: ReachLink’s licensed clinical social workers are trained in evidence-based therapeutic approaches for personality disorders, including psychodynamic psychotherapy, cognitive behavioral therapy, transference-focused psychotherapy, and schema-focused therapy. However, if you require psychiatric evaluation or medication management in addition to therapy, you will need to consult with a psychiatrist or other medical professional authorized to prescribe medications, as ReachLink does not provide prescription services.

Telehealth options for NPD therapy

Because the therapist-client relationship is particularly integral in treating NPD, you may consider telehealth therapy options, which can provide access to specialized therapists who might not be available in your geographic area. Telehealth platforms like ReachLink offer the flexibility to connect with licensed clinical social workers who have expertise in treating personality disorders through secure video sessions.

Telehealth therapy eliminates geographical barriers and provides scheduling flexibility, which can be particularly valuable when seeking specialized treatment. The ability to attend sessions from a comfortable, private location may also reduce some of the initial resistance to seeking help that many individuals with NPD experience.

Research supporting telehealth for personality disorders

Research demonstrates that telehealth therapy can be just as effective as traditional in-person therapy for treating a range of mental health conditions, including personality disorders. Studies have found that online delivery of cognitive behavioral therapy, one of the common treatments for NPD, results in “high patient satisfaction” and comparable clinical outcomes to in-person treatment.

The continuity of care possible through telehealth—with consistent access to the same therapist regardless of travel, relocation, or scheduling conflicts—can be particularly beneficial for personality disorder treatment, which often requires sustained therapeutic engagement over time.

Moving toward change and healing

Narcissistic personality disorder can have profound negative impacts on your life, including emotional instability and significant challenges in close relationships. The good news is that therapeutic interventions such as psychodynamic psychotherapy, cognitive behavioral therapy, transference-focused psychotherapy, and schema-focused therapy may help reduce the severity of NPD symptoms and improve interpersonal functioning.

Change requires significant commitment, self-reflection, and willingness to engage authentically in the therapeutic process. While the journey may be challenging, many individuals with NPD who commit to therapy experience meaningful improvements in their relationships, emotional regulation, and overall quality of life.

Telehealth platforms like ReachLink offer a convenient and accessible way to connect with licensed clinical social workers skilled in these specific NPD treatment techniques. With the right therapeutic support and personal commitment to change, it is possible to develop healthier relationship patterns and greater emotional well-being.

Disclaimer: The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional.